Journal articles on the topic 'France. Saint-Etienne'

The church of Saint-Etienne (Saint-Vaast) in Beauvais was much discussed in the early literature on medieval architecture, particularly in regard to the vaults over the initial bays of the nave aisles. The vaults have long been considered among the earliest rib vaults in northern France, although their exact date had never been determined. The challenge to date these vaults precisely became critical in the late 1950s when local excavations under the present Late Gothic choir uncovered evidence that the original choir may have been rib-vaulted as well. This paper analyzes these unpublished excavations and their implications for the extant vaults of the nave aisles; it also provides a credible dating for the choir and these vaults. In the absence of constructional documents, the dating of Saint-Etienne must depend on stylistic comparisons correlated with the dates of major historical incidents in Beauvais that would have influenced the construction of the church. All of these factors taken together seem to indicate strongly the existence of a fully rib-vaulted choir at Saint-Etienne and of a unified campaign of construction encompassing this choir, the transept, and the initial bays of the nave aisles. Most significantly, a date as early as the 1070s is suggested for the vaults of the choir, thus making them the earliest known rib vaults in medieval architecture and forcing a re-examination of the structural aspect of medieval style in the 11th century.

This article contains a synthesis of thoughts and conclusions formulated at the close of a research programme entitled ‘Characterization of research–industry relations: the geographical role polarization plays in the competitiveness of Computer Integrated Manufacturing’. This document focuses on the particular case of Meylan's ZIRST, though the research programme was based on several case studies of technopoles of Computer Integrated Manufacturing, including Sophia-Antipolis and the Computer Integrated Manufacturing's poles – Nord/Pas-de-Calais and Saint-Etienne in France and Gothenberg in Sweden.

Professionals and volunteers in inter-war England and France advanced a ‘modern’ health movement, placing particular emphasis on children's physical condition. The use of the urban clinic in this process has been considered. However, the mass relocation of young people to the countryside and attempts to generate intra-urban spaces of ‘nature’ for the young were also integral to this movement. Surprisingly, the pioneers of modern urban healthcare supported a ‘return to nature’ by mobilizing anti-urban and pro-rural discourse. Comparing Nottingham and Saint-Etienne, this article addresses the politics that produced this paradox.

This paper explores how maps can support water quality management as part of a common project between a water management organization (Service Départementale de L’eau du Conseil Général de Haute-Loire - France) and a research laboratory (Centre de Recherche sur l’Environnement et l’Aménagement - Université de Saint-Etienne - France). Visualization tools are proposed to bring together the different stakeholders in the negotiation process for water management. Two fundamental questions are examined here: (1) how do we communicate the different water quality information to the various stakeholders to improve their awareness of the environment; and (2) how could we evaluate the effectiveness of a cartographic visualization system in the process of negotiation between different stakeholders. Alternative methods are proposed here to present and evaluate water quality information in the form of maps.

ABSTRACTA study comparing the ICT (immunochromatography technology)ToxoplasmaIgG and IgM rapid diagnostic test (LDBio Diagnostics, France) with a fully automated system, Architect, was performed on samples from university hospitals of Marseille and Saint-Etienne. A total of 767 prospective sera and 235 selected sera were collected. The panels were selected to test various IgG and IgM parameters. The reference technique,ToxoplasmaIgGII Western blot analysis (LDBio Diagnostics), was used to confirm the IgG results, and commercial kits Platelia Toxo IgM (Bio-Rad) and Toxo-ISAgA (bioMérieux) were used in Saint-Etienne and Marseille, respectively, as the IgM reference techniques. Sensitivity and specificity of the ICT and the Architect IgG assays were compared using a prospective panel. Sensitivity was 100% for the ICT test and 92.1% for Architect (cutoff at 1.6 IU/ml). The low-IgG-titer serum results confirmed that ICT sensitivity was superior to that of Architect. Specificity was 98.7% (ICT) and 99.8% (Architect IgG). The ICT test is also useful for detecting IgM without IgG and is both sensitive (100%) and specific (100%), as it can distinguish nonspecific IgM from specificToxoplasmaIgM. In comparison, IgM sensitivity and specificity on Architect are 96.1% and 99.6%, respectively (cutoff at 0.5 arbitrary units [AU]/ml). To conclude, this new test overcomes the limitations of automated screening techniques, which are not sensitive enough for IgG and lack specificity for IgM (rare IgM false-positive cases).

The unpredictable French health care reform of 1995-96 introduced casemix tools to fund French hospitals at a regional level. After two years (1997-98), health care authorities and hospitals are facing great inequities and inefficiencies (1 to 3) in 22 French regions. Onlyone region (Ile de France, Paris) is above the national casemix index mean, the Index Synthetique d'Activite, and very few are equal to this national mean. The dilemma for most of the 22 regions under this national mean, and within a region like Rhone-Alpes (Saint- Etienne), with inequities from 1 to 2, is to decide whether the main goal of the new health care policy is to reduce inequities and inefficiencies.

Auguste Bravais by his fundamental work on lattice has pioneered modern crystallography. He was born in 1811 in Annonay (France) at a short distance from Lyon and Saint-Etienne. He was then educated at the College Stanislas in Paris and entered the École Polytechnique in Paris in 1829. In 1832, he joined the French Navy as an officer and took part at scientific explorations to the Algerian Coast and Northern Europe. In 1837 he defended a PhD in Astronomy at the Faculty of Sciences in Lyon where he became Professor in 1841 to teach mathematics in astronomy. Then, in 1845, he moved at Ecole Polytechnique in Paris to take the chair of Physics, which he held till 1856. He published his first studies dealing with crystal lattice in 1849 in a short paper [1] and later wrote a book where he developed his theory fully based on geometrical theorems [2]. He died prematurely in 1863 exhausted by the loss of his only son. Like many scientists of that time Auguste Bravais was universalist and has been successively astronomer, geologist, mathematician, physicist, mineralogist, and crystallographer as well as an explorer from Lapland to the top of Mont Blanc [3]. In this communication, the steering committee Lyon-Saint-Etienne will recall the contribution of Auguste Bravais to crystallography and will show some aspect of his life that may be less known in our community.

Current laparoscopic bariatric operations (e.g. gastric bypass and sleeve gastrectomies) require systematically the use of an energy device, meant for dissection and coagulation. Several companies make them, the US Medtronic and Ethicon being dominant, with published favorable results. A trial has been conducted with devices created by the company REACH Surgical Inc (Beijin, China): Sound Reach device in two centers in France (Lyon, Saint-Etienne) and three different surgeons. Thirty interventions have been carried out (21 sleeve gastrectomies, 1 bypass, and 8 gastric band removals), 27 F and 3 H, mean age 40, mean weight 99 kg, and mean BMI 40,4. From 0 to 5, the average note for ergonomics has been 3.5, and 4.5 for safety. There was no intra-operative incidents, but a post-operative hematoma treated by surveillance only at D2. The overall impression has been that this device was safe and effective.

de ROUEN, Saint Etienne du Rouvray, Cedex, France AU Jemni A. AF Laboratoire d?Etudes de Syst?mes thermiques et Energ?tique (LESTE), Monastir, Tunisie KW premixed turbulent combustion % numerical simulation % V-flame KR nema AB In this paper we simulate a turbulent premixed V-shape flame stabilized on a hot wire. The device used is composed of a vertical combustion chamber where the methane-air mixture is convected upwards with a mean velocity of 4ms-1. The flow was simulated running Fluent 6.3, which numerically solved the stationary Favre-averaged mass balance; Navier-Stokes equations; combustion progress variable, and k-? equations on a two-dimensional numerical mesh. We model gaseous mixture, ignoring Soret and Dufour effects and radiation heat transfer. The progress variable balance equation was closed using Eddy Break Up model. The results of our simulations allow us to analyze the influence of equivalence ratio and the turbulent intensity on the properties of the flame (velocity, fluctuation, progress variable and Thickness of flame).This work gives us an idea on the part which turbulence can play to decrease the risks of extinction and instabilities caused by the lean premixed combustion. nema

Mobile phones (MPs) of healthcare workers (HCWs) may represent an important source of transmission of infectious agents. This longitudinal study documents the contamination of these tools. Ten MPs handled by senior pediatricians were sampled once a week during 23 weeks in three pediatric wards of the University Hospital of Saint-Etienne, France. Cultures were performed for bacteria and multiplex PCR assays for a panel of respiratory and enteric viruses. A questionnaire on hygiene habits regarding phoning and care was filled-in by pediatricians before and after the study. From a total of 230 samples, 145 (63%) were contaminated by at least one pathogen. The MPs from emergency departments were the most impacted. Viruses were detected in 179 samples; bacteria were isolated in 59 samples. Contamination increased during the winter epidemic peak. A cross-contamination by Paracoccus yeei between hands and MPs of different HCWs was demonstrated. The communication of the study results influenced the hygiene behaviors. This study highlights the contamination of MPs by pathogens that are resistant in the environment, and its sustainability along the winter season. The role of MPs as vectors of nosocomial infection needs to be better investigated.

ABSTRACTLegionellaspp. are frequently isolated in hospital water systems. Heat shock (30 min at 70°C) is recommended by the World Health Organization to control its multiplication. The aim of the study was to evaluate retrospectively the efficacy of heat treatments by using a flow cytometry assay (FCA) able to identify viable but nonculturable (VBNC) cells. The study includedLegionellastrains (L. pneumophila[3 clusters] andL. anisa[1 cluster]) isolated from four hot water circuits of different hospital buildings in Saint-Etienne, France, during a 20-year prospective surveillance. The strains recovered from the different circuits were not epidemiologically related, but the strains isolated within a same circuit over time exhibited an identical genotypic profile. After anin vitrotreatment of 30 min at 70°C, the mean percentage of viable cells and VBNC cells varied from 4.6% to 71.7%. Thein vitrodifferences in heat sensitivity were in agreement with the observed efficacy of preventive and corrective heating measures used to control water contamination. These results suggest thatLegionellastrains can become heat resistant after heating treatments for a long time and that flow cytometry could be helpful to check the efficacy of heat treatments onLegionellaspp. and to optimize the decontamination processes applied to water systems for the control ofLegionellaproliferation.

La pollution des sols dans la région de Saint-Etienne (42-France) constitue aujourd'hui une dimension majeure de l'aménagement et du renouvellement urbain. Après avoir été longtemps ignorée au profit de la pollution de l'eau et de l'air, voire minorée par indifférence, la pollution des sols est peu à peu prise en compte par les acteurs locaux aidés en cela par une mise à l'agenda nationale. En effet, pour silencieuse qu'elle soit, la pollution des sols ne s'en inscrit pas moins dans une réglementation opérationnelle. Au-delà d'une accommodation à l'échelle des sites, laquelle génère parfois quelques tensions avec l'Etat perçu comme plus contrôleur qu'accompagnateur par les acteurs locaux, quelques initiatives montrent une capacité d'action plus ferme dans la gestion de cet héritage voire des capacités à innover tant dans les solutions techniques que dans la configuration des relations entre acteurs. Pour autant, elles ne relèvent pas du « rebond » emblématisé et normalisé qui amène à qualifier villes et territoires de résilients mais, au-delà de l'accommodement des projets à la pollution des sols, elles invitent à penser la résilience à partir de la réalité des sociétés localisées et d'une réappropriation politique des héritages industriels plutôt qu'à partir de « résultats » attendus et indexés à des modèles de redéveloppement emblématisés.

Background Approximately 70%-80% of kidney cancers are clear cell renal cell carcinomas (CCRCCs). Patient management is based on imaging (abdominal ultrasound and computerized tomography), surgical excision of the tumor, and pathological analysis. A tissue biopsy is therefore necessary to confirm the diagnosis and avoid unnecessary nephrectomy. For metastatic cancers, a tissue biopsy is essential for establishing the targeted therapy. This biopsy of tumor material is invasive and painful. Other techniques such as liquid biopsy would help reduce the need for tissue biopsy. The development of a simple biological test for diagnosis is essential. CA9 is a powerful marker for the diagnosis of CCRCC. Exosomes have become a major source of liquid biopsy because they carry tumor proteins, RNA, and lipids. Urine is the most convenient biological liquid for exosome sampling. Objective The aim of this study (PEP-C study) is mainly to determine whether it is possible to detect urinary exosomal CA9 for the molecular diagnosis of CCRCC. Methods This study will include 60 patients with CCRCC and 40 noncancer patients. Exosomes will be isolated from urine samples and exosomal CA9 will be detected by transmission electron microscopy, flow cytometry, and reverse transcription-quantitative polymerase chain reaction. Results This study is currently underway with funding support from the CHU Saint-Etienne of France. Conclusions We expect to demonstrate that urinary tumor exosomes could be a novel liquid biopsy to diagnose CCRCC and to guide clinicians in treatment decision-making. Trial Registration ClinicalTrials.gov NCT04053855; https://clinicaltrials.gov/ct2/show/NCT04053855 International Registered Report Identifier (IRRID) DERR1-10.2196/24423

Abstract This retrospective study was designed to determine the prevalence of inherited prothrombotic risk factors (Factor V Leiden (FV) G1691A and prothrombin G20210A mutations, TT677 genotype of the methylenetetrahydrofolate reductase (MTHFR), protein C, protein S, antithrombin deficiencies) in a population of children with ALL treated according to the FRALLE 2000 study Protocol (High Risk and Standard Risk groups). The study was performed in 5 French Centers including Amiens, Angers, Paris Trousseau, Rouen and Saint-Etienne. From December 2000 to March 2006, 354 children aged 1 to 18 years old were consecutively admitted for ALL and were enrolled in the FRALLE 2000 Protocol. Among them, 281 patients were investigated for hereditary prothrombotic defects at the time of ALL diagnosis. Informed parental consent was required for gene analysis. Abnormal test results for protein S (functional activity and free protein S antigen concentration), protein C and antithrombin were controlled on a second blood sample after induction. In the population studied, the prevalence of one established prothrombotic risk factor was 19,2%: the FV G1691A mutation was diagnosed in 10 patients (3.6%), all heterozygous, 10 patients (3.6%) showed the heterozygous prothrombin G20210A mutation, the TT677 MTHFR genotype was found in 34 children (12.7%), 1 patient showed protein C deficiency (0.4%). No antithrombin deficiency was detected. The prevalence of inherited protein S deficiency could not be evaluated because of missing data in the family medical history. Combined prothrombotic defects were found in 2 patients (0.71%): heterozygous FV G1691A mutation combined with heterozygous prothrombin G20210A mutation in 1 patient and combined with TT677 MTHFR genotype in the second patient. Except for TT677 MTHFR genotype, the prevalence of hereditary prothrombotic risk factors in children with ALL in France were found within the prevalence reported for children treated for ALL (table 1) and comparable to the prevalence in healthy Europeans (Junker et al. 1999, Margaglione et al 2001, Mueller et al. 2005). Comparison of the prevalence of inherited prothrombotic risk factors in children with ALL Country Population FV G1691A +/− ++ PT G20210A +/− +/+ MTHFR TT677 AT PC AT: antithrombin deficiency ; PC: protein C deficiency ; NE : non evaluated NowakGöttl et al 1999 (n=301) Germany ALL children 5.3% 0.3% 2% 0% 7.7% 0.7% 2.3% Mauz-Körholz et al. 2000 (n=108) Germany ALL children 5.6% 0% 2.8% 0% 5.6% 0% 2.7% Mitchell et al. 2002 (n=60) Canada ALL children 3.3% 0% 2% 0% NE NE NE Present study (n=281) France ALL children 3.6% 0% (n=277) 3.6% 0%(n=279) 2.7% (n=268) 0% 0.4%

Background:In knee osteoarthritis (KOA) recommendations, the first pharmacological analgesic line is paracetamol. However, its low efficacy, frequently leads to the use of weak opioids (WO) despite their poor tolerance, especially in elderly patients.Objectives:The primary objective was to compare analgesic efficacy and safety of a new wearable transcutaneous electrical nerve stimulation (W-TENS) to those of WO in the treatment of moderate to severe, nociceptive, chronic pain in KOA patients.Methods:ArthroTENS study was a phase 3, non-inferiority, multicentric, prospective, randomized, single-blinded for primary efficacy outcome, controlled, in 2-parallel groups, clinical study comparing W-TENS versus WO on two periods: a 3-month controlled period and an additional, optional, non-controlled, 3-month follow-up for patients in W-TENS group.Eligible participants were KOA patients, ≥55 years old, at Kellgren-Lawrence radiographic grade ≥2, with moderate to severe nociceptive chronic (≥3 months) mean 8-day pain ≥4 on a 11-point numerical rating scale, and in treatment failure with non-opioid analgesics, including NSAIDs. Patients with neuropathic pain were excluded.Co-primary endpoints were, for efficacy, mean pain intensity (PI), assessed at M3 and, for safety, the number of adverse events (AE) during the 3-month follow-up period.In W-TENS group, an advanced, mobile app enabled, wearable TENS was used. High (100 Hz) and low (2 Hz) frequency stimulations were delivered via electrodes with standardized positioning (Figure 1).Figure 1.Electrode’s positioningIn WO group, investigators chose, for each patient, the best suitable WO and its daily dose, and could switch to another WO, and/or adapt its daily dose if necessary.A non-inferiority analysis was performed on the primary efficacy endpoint using a pre-defined non-inferiority margin (0.825 point) on PI, below the minimal clinically significant improvement.Results:Demographic and baseline characteristics were balanced across both groups.110 patients (55/group) were randomized and 48/55 (87.3%) and 44/55 (80.0%) patients completed the 3-month follow-up in W-TENS and WO groups, respectively. WO’s prescriptions were balanced between codeine, opium-powder, tramadol and WO-paracetamol combinations.Non-inferiority of W-TENS was demonstrated in the PP and ITT populations (Table 1). Since the 95% confidence interval (CI) of the between-treatments difference was below 0 in the ITT population, a planned superiority analysis was performed showing that W-TENS was significantly superior to WO at M3 (p=0.0124) on PI. Additionally, the number of AEs was significantly lower (p<0.001) in W-TENS (n=7) group than in WO (n=36) group. In WO group, AEs were systemic AEs usually reported with WO while AEs in W-TENS group were local, related to the technique used, such as local cutaneous reaction (erythema).Table 1.Non-inferiority analyses on pain intensity at M3. ITT and PP populations. Least squares means for each study group and study group difference estimate and corresponding 95% CIGroup PopulationWithin-group changeBetween-group differenceW-TENSWOW-TENS - WOITT Population (n)5555Non inferiorityMean (SD)3.83 (0.28)<0.0014.74 (0.28)<0.001-0.92 (0.40)Non inferiority‡ demonstrated95% CI[3.27, 4.40][4.18, 5.30][-1.71, -0.12]PP Population (n)5247Mean (SD)3.87 (0.30)<0.0014.66 (0.32)<0.001-0.79 (0.44)Non inferiority‡ demonstrated95% CI[3.28, 4.46][4.03, 5.28][-1.65, 0.08]‡ Noninferiority was demonstrated when 95% CI < 0.825Thirty-nine (70.9%) patients wished to extend W-TENS treatment for 3 additional months. Only one patient discontinued this additional period and results obtained at M3 remained stable at M6.Conclusion:In this study, W-TENS was more effective and better tolerated than WO in the treatment of nociceptive KOA chronic pain and should represent an interesting non-pharmacological alternative to WO.Acknowledgements:We gratefully thank P. Fardellone (Amiens), E. Coudeyre (Clermont-Ferrand), Y. Donazzolo (Gieres), A. Amouzougan (Saint-Etienne), L. Grange (Grenoble), T. Conrozier (Belfort), E. Senbel (Marseille), J.P. Sanchez (Billere), R. Forestier (Aix-les-Bains), H. Bard (Paris) and E. Gibert (Ivry-sur-Seine) for their active contribution throughout arthroTENS studyDisclosure of Interests:Emmanuel Maheu Speakers bureau: TRB chemedica, Consultant of: SUBLIMED, Moirans, FRANCE; Sandrine Soriot-Thomas Speakers bureau: Grunenthal, Consultant of: SUBLIMED, Moirans, FRANCE;GrunenthalKyowa Kirin pharma, Grant/research support from: GrunenthalSanofiTevaMylanTherable, Eric Noel Consultant of: SUBLIMED, Moirans, FRANCE; Eric Lespessailles Consultant of: SUBLIMED, Moirans, FRANCE; Bernard Cortet Consultant of: SUBLIMED, Moirans, FRANCE;

Background The increase in the number of cancer cases and the evolution of cancer care management have become a significant problem for the French health care system, thereby making patient empowerment as a long sought-after goal in chronic pathologies. The implementation of an activation measure via the Patient Activation Measure-13 item (PAM-13) in the course of cancer care can potentially highlight the patient’s needs, with nursing care adapting accordingly. Objective The objectives of this PARACT (PARAmedical Interventions on Patient ACTivation) multicentric study were as follows: (1) evaluate the implementation of PAM-13 in oncology nursing practices in 5 comprehensive cancer centers, (2) identify the obstacles and facilitators to the implementation of PAM-13, and (3) produce recommendations for the dissemination of such interventions in other comprehensive cancer centers. Methods This study will follow the “Reach, Effectiveness, Adoption, Implementation, and Maintenance” framework and will consist of 3 stages. First, a robust preimplementation analysis will be conducted using the Theoretical Domains Framework (TDF) linked to the “Capability, Opportunity, Motivation, and Behavior” model to identify the obstacles and facilitators to implementing new nursing practices in each context. Then, using the Behavior Change Wheel, we will personalize a strategy for implementing the PAM-13, depending on the specificities of each context, to encourage acceptability by the nursing staff involved in the project. This analysis will be performed via a qualitative study through semistructured interviews. Second, the patient will be included in the study for 12 months, during which the patient care pathway will be studied, particularly to collect all relevant contacts of oncology nurses and other health professionals involved in the pathway. The axes of nursing care will also be collected. The primary goal is to implement PAM-13. Secondary factors to be measured are the patient’s anxiety level, quality of life, and health literacy level. The oncology nurses will be responsible for completing the questionnaires when the patient is at the hospital for his/her intravenous chemotherapy/immunotherapy treatment. The questionnaires will be completed thrice in a year: (1) at the time of the patient’s enrollment, (2) at 6 months, and (3) at 12 months. Third, a postimplementation analysis will be performed through semistructured interviews using the TDF to investigate the implementation problems at each site. Results This study was supported by a grant from the French Ministry of Health (PHRIP PARACT 2016-0405) and the Lucien Neuwirth Institute of Cancerology of Saint-Etienne, France. Data collection for this study is ongoing. Conclusions This study would improve the implemented targeted nursing interventions in cancer centers so that a patient is offered a personalized cancer care pathway. Furthermore, measuring the level of activation and the implementation of measures intended to increase such activation could constitute a significant advantage in reducing social health inequalities. Trial Registration ClinicalTrials.gov NCT03240341; https://clinicaltrials.gov/ct2/show/NCT03240341 International Registered Report Identifier (IRRID) DERR1-10.2196/17485

Abstract INTRODUCTION Women with a history of venous thromboembolism (VTE) have a 2% to 10% absolute risk of developing pregnancy-associated recurrent VTE. Based on these figures, current guidelines recommend postpartum thromboprophylaxis in all pregnant women with a history of VTE. Women with a moderate or high risk of recurrent VTE (i.e. women with a history of VTE that is either unprovoked or associated with a hormonal or minor risk factor), should also receive thromboprophylaxis antepartum. The optimal dose of low-molecular-weight heparin (LMWH) for thromboprophylaxis in pregnant women at moderate or high risk of recurrent VTE is currently unknown, as only two very small prospective trials, both with methodological limitations, have evaluated pharmacological prevention of recurrent VTE in this population. Therefore, the major international guidelines suggest the use of either a prophylactic or intermediate (half-therapeutic) dose of LMWH in this setting, without a preference of one dose over the other. The Highlow study is an investigator-initiated, multicenter, international, open-label, randomized controlled trial (RCT) that compares the efficacy and safety of a fixed dose of LMWH versus an intermediate dose of LMWH for the prevention of pregnancy-associated recurrent VTE (NCT 01828697; www.highlowstudy.org). The rationale and design features of the Highlow study were recently published [Bleker SM, Thromb Res, 2016]. Here, we present an interim report. METHODS In April 2013, we enrolled the first patient in the Highlow study. For the current report, we analyzed the enrolment rates and baseline characteristics of patients in the Highlow study between 1 April 2013 and 28 June 2016. Twelve centers recorded eligible women that did not give informed consent. Using the enrolment data from these centers, we analyzed the percentage of women giving informed consent, and reasons for not giving consent. All characteristics were summarized using descriptive statistics. RESULTS A total of 222 pregnant patients with a history of VTE that fitted the in- and exclusion criteria of the Highlow study were enrolled in 43 centers in 5 countries (Figure 1). The inclusion rate has been growing exponentially over time (Figure 2). In 12 centers that recorded eligible women not giving consent, 101 of 149 identified patients gave informed consent (68%). Patients who declined participation either did not give a specific reason (N=22; 46%), preferred a low dose of LMWH (N=20; 42%), preferred an intermediate dose (N=2; 4%), preferred a therapeutic dose (N=2; 4%), refused antepartum prophylaxis (N=1; 2%) or had been advised by another physician not to participate (N=1; 2%). On 28 June 2016, baseline data in the CRF had been completed for 181 patients. Six patients participated twice. The mean age was 33 years ± 5.1, with a mean body mass index of 26.7 ± 5.9. The majority had a history of lower limb deep vein thrombosis (N=102; 56%) or pulmonary embolism (N=72, 40%). Of all previous VTE, the majority was hormone-related (N=97; 54%) or related to pregnancy (N=58; 32%). In total, 34 (19%) of prior VTE were unprovoked, and in only 19 cases (11%) a minor risk factor had been present. Thrombophilia screening had been performed previously in 101 patients (56%) and more than half of them (59 patients, 58%) had positive tests, especially for heterozygous factor V Leiden (N=39; 64%) and the heterozygous prothrombin 20210A mutation (N=13; 22%). CONCLUSIONS This report represents the largest number of pregnant women with a history of VTE participating in a RCT to date, and the future results are very likely to impact current clinical practice and consensus guidelines. Reassuringly, our enrolment rate shows that recruitment of pregnant women with a history of VTE is feasible. With the current enrolment rate we expect to include the last patient, reaching the event-driven sample size of approximately a 1000 patients, by the end of 2019. Hence, the outcome results can be expected in 2020. SPONSORSHIP AND FINANCIAL SUPPORT An unrestricted grant is provided by Aspen Pharma to the Academic Medical Center in Amsterdam (the Netherlands), who is the sponsor of the Highlow study. In France, where CHU de Saint Etienne is the sponsor, a grant was acquired from the French Ministry of Health (PHRC national 2014). Figure 1 NUMBER OF ENROLLED PATIENTS FROM APRIL 2013 TO JUNE 2016 Figure 1. NUMBER OF ENROLLED PATIENTS FROM APRIL 2013 TO JUNE 2016 Figure 2 NUMBER OF INCLUSIONS PER QUARTILE Figure 2. NUMBER OF INCLUSIONS PER QUARTILE Disclosures Buchmüller: French Ministry of Health: Research Funding. Chauleur:Sanofi: Honoraria; French Ministry of Health: Research Funding. Ní Áinle:Actelion UK: Research Funding. Verhamme:Boehringer Ingelheim: Honoraria, Research Funding; Bayer-Healthcare: Honoraria, Research Funding; Pfizer: Honoraria; Sanofi-Aventis: Honoraria, Research Funding; LeoPharma: Research Funding; Daiichi-Sankyo: Honoraria. Décousus:French Ministry of Health: Research Funding.

RESUMENEl objetivo de este artículo es reflexionar sobre los mecanismos de financiación y de control de las instituciones religiosas por los laicos en las primeras décadas de la conquista y colonización de Hispanoamérica. Investigar sobre la inversión laica en lo sagrado supone en un primer lugar aclarar la historiografía sobre laicos, religión y dinero en las sociedades de Antiguo Régimen y su trasposición en América, planteando una mirada desde el punto de vista de las motivaciones múltiples de los actores seglares. A través del ejemplo de restituciones, donaciones y legados en losAndes, se explora el papel de los laicos españoles, y también de las poblaciones indígenas, en el establecimiento de la densa red de instituciones católicas que se construye entonces. La propuesta postula el protagonismo de actores laicos en la construcción de un espacio cristiano en los Andes peruanos en el siglo XVI y principios del XVII, donde la inversión económica permite contribuir a la transición de una sociedad de guerra y conquista a una sociedad corporativa pacificada.PALABRAS CLAVE: Hispanoamérica-Andes, religión, economía, encomienda, siglos XVI y XVII.ABSTRACTThis article aims to reflect on the mechanisms of financing and control of religious institutions by the laity in the first decades of the conquest and colonization of Spanish America. Investigating lay investment in the sacred sphere means first of all to clarifying historiography on laity, religion and money within Ancien Régime societies and their transposition to America, taking into account the multiple motivations of secular actors. The example of restitutions, donations and legacies inthe Andes enables us to explore the role of the Spanish laity and indigenous populations in the establishment of the dense network of Catholic institutions that was established during this period. The proposal postulates the role of lay actors in the construction of a Christian space in the Peruvian Andes in the sixteenth and early seventeenth centuries, when economic investment contributed to the transition from a society of war and conquest to a pacified, corporate society.KEY WORDS: Hispanic America-Andes, religion, economics, encomienda, 16th and 17th centuries. BIBLIOGRAFIAAbercrombie, T., “Tributes to Bad Conscience: Charity, Restitution, and Inheritance in Cacique and Encomendero Testaments of 16th-Century Charcas”, en Kellogg, S. y Restall, M. (eds.), Dead Giveaways, Indigenous Testaments of Colonial Mesoamerica end the Andes, Salt Lake city, University of Utah Press, 1998, pp. 249-289.Aladjidi, P., Le roi, père des pauvres: France XIIIe-XVe siècle, Rennes, Presses universitaires de Rennes, 2008.Alberro, S., Les Espagnols dans le Mexique colonial: histoire d’une acculturation, Paris, A. Colin, 1992.Alden, D., The making of an enterprise: the Society of Jesus in Portugal, its empire, and beyond 1540-1750, Stanford California, Stanford University Press, 1996.Angulo, D., “El capitán Gómez de León, vecino fundador de la ciudad de Arequipa. Probança e información de los servicios que hizo a S. M. en estos Reynos del Piru el Cap. 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In 1250, the French monk and inquisitor Etienne de Bourbon described a strange cult he had found in the Dombes, a poor agricultural region North of Lyon in France. In confession, he had heard many women who recognized that they had prayed to Saint Guinefort, Martyr. Upon inquiring on the saint unknown to him, de Bourbon found out that Guinefort was a dog. Taking into account Jung's reflections on animals and his notion of conjunctio oppositorum, this paper will examine the reasons why, in the thirteenth century France, the peasants' piety canonized a dog, a fact unique in Christian history. This question will be addressed here in two steps: why did the French peasants include a dog among the Christians saints, and what does today's anthropozoology have to say about animals' healing powers.

Economic opportunity in the 21st century privileges people and places with the “right mix” of human capital to develop and apply digital technologies, and disadvantages those without. Increasing socio-technical, socio-economic, and socio-spatial polarization underscores inclusion as a critically important dimension of innovation. Workforce development and entrepreneurial ecosystems each have implications for “inclusive innovation” in restructuring cities, but understanding their realistic prospects requires attention to local institutional capacity as well as the broader multilevel policy contexts in which they operate. This study compares inclusive innovation programs in Saint-Etienne, France and Greensboro North Carolina, two mid-sized restructuring cities operating in two different macro-institutional settings. Highly variable but not entirely idiosyncratic dynamics emerge in each case; inclusive innovation is integral in Saint Etienne and incidental in Greensboro but not a resounding success in either city. “Top-down” and “bottom-up” dynamics interact in different ways to shape outcomes, but power matters most for local policy choice. The decisive factor is explicit linkage to a commonly accepted urban development agenda that is supported politically by local government. Intermediary organizations lack influence, and the private sector is disengaged. These findings suggest the need to rethink assumptions about the actor configurations that determine urban development priorities.

AbstractWe use the United Nations COMTRADE database for analysis of the multiproduct world trade network. With this data, considered for years 2012–2018, we determined the world trade impact of the Kernel of EU 9 countries (KEU9), being Austria, Belgium, France, Germany, Italy, Luxembourg, Netherlands, Portugal, Spain, considered as one united country. We apply the advanced Google matrix analysis for investigation of the influence of KEU9 and show that KEU9 takes the top trade network rank positions thus becoming the main player of the world trade being ahead of USA and China. Our network analysis provides additional mathematical grounds in favor of the recent proposal (Saint-Etienne in: Osons l’Europe des Nations. Editions de l’Observatoire/Humensis, Paris, 2018) of KEU9 super-union which is based only on historical, political and economy basis.

The alloys Haynes 230 and Inconel 617 are potential candidates for the intermediate heat exchangers (IHXs) of (very) high temperature reactors ((V)-HTRs). The behavior under corrosion of these alloys by the (V)-HTR coolant (impure helium) is an important selection criterion because it defines the service life of these components. At high temperature, the Haynes 230 is likely to develop a chromium oxide on the surface. This layer protects from the exchanges with the surrounding medium and thus confers certain passivity on metal. At very high temperature, the initial microstructure made up of austenitic grains and coarse intra- and intergranular M6C carbide grains rich in W will evolve. The M6C carbides remain and some M23C6 richer in Cr appear. Then, carbon can reduce the protective oxide layer. The alloy loses its protective coating and can corrode quickly. Experimental investigations were performed on these nickel based alloys under an impure helium flow (Rouillard, F., 2007, “Mécanismes de formation et de destruction de la couche d’oxyde sur un alliage chrominoformeur en milieu HTR,” Ph.D. thesis, Ecole des Mines de Saint-Etienne, France). To predict the surface reactivity of chromium under impure helium, it is necessary to determine its chemical activity in a temperature range close to the operating conditions of the heat exchangers (T≈1273 K). For that, high temperature mass spectrometry measurements coupled to multiple effusion Knudsen cells are carried out on several samples: Haynes 230, Inconel 617, and model alloys 1178, 1181, and 1201. This coupling makes it possible for the thermodynamic equilibrium to be obtained between the vapor phase and the condensed phase of the sample. The measurement of the chromium ionic intensity (I) of the molecular beam resulting from a cell containing an alloy provides the values of partial pressure according to the temperature. This value is compared with that of the pure substance (Cr) at the same temperature. These calculations provide thermodynamic data characteristic of the chromium behavior in these alloys. These activity results call into question those previously measured by Hilpert and Ali-Khan (1978, “Mass Spectrometric Studies of Alloys Proposed for High-Temperature Reactor Systems: I. Alloy IN-643,” J. Nucl. Mater., 78, pp. 265–271; 1979, “Mass Spectrometric Studies of Alloys Proposed for High-Temperature Reactor Systems: II. Inconel Alloy 617 and Nimomic Alloy PE 13,” J. Nucl. Mater., 80, pp. 126–131), largely used in the literature.

Abstract Background and Aims While being a GFR biomarker with comparable performance than serum creatinine (SCr), Serum cystatin C (ScysC) is a better predictor of morbi-mortalilty in the general as well as the CKD population. The mechanisms underlying the prognostic dimension of ScysC are unclear. Unlike SCr, ScysC is known to strongly and positively correlate to C Reactive Protein (CRP) and thereby could reflect autonomic nervous system (ANS) dysfunction. Transversal studies have underlined the association between the decline in autonomic nervous system (ANS) activity and all-cause mortality. ANS is thought to reflexively regulate the inflammatory response (« inflammatory reflex ») and autonomic dysfunction has been shown to be associated with deleterious sustained inflammatory stress. The Proof study is a prospective observational cohort of 1011 individuals, all aged 65 years at baseline (i.e. 2001), that was designed to assess the prognostic values of the ASN activity and its decline for the cardiovascular morbidity and mortality. We took advantage of the Proof cohort to explore the relationship between ScysC and ANS activity. Method The PROOF Cohort Study (PROgnostic indicator OF cardiovascular and cerebrovascular events) is constituted of elderly subjects aged 65 years in 2001 recruited from the electoral list of Saint-Etienne, France. Three initial 2-year examination were scheduled (2001–2007) along with late events monitoring which is still ongoing. At each examination, ANS activity was evaluated (baroreflex sensitivity by TILT testing) along with clinical and biological cardiovascular risk factors. Individuals with diagnosed CKD, history of myocardial infarction or stroke, heart failure, insulin-dependent diabetes mellitus, and a severe disease that limited life expectancy to 5 years or less could not be included in the Proof cohort. SCr and ScysC were measured from sera drawn at baseline and stored at -80°C, using IDMS-traceable enzymatic method and immunoturbidimetry calibrated method, respectively. Relationhip between SCysC and baroreflex sensitivity was analysed by univariate linear and multivariate logistic regressions. Results SCr and ScysC were measured in 803 patients of the Proof Cohort (71% of men) follow up to December 2019. Mean (+/- SD) SCr was 77 (+/- 15) micromol/l. ScysC was significantly associated to 18 years - all cause mortality (OR=4.1, p=0.01) and baseline CRP (p= 0.002). In univariate analysis, ScysC was the covariate most strongly associated to impaired BRS (coeff=-1.62, p=0.02), followed by diabetes (coeff=-0.73, p=0;04), gender (coeff=-0.59, p=0.001), hypertension (coeff=-0;48, p=0.009), active smoking (-0.47, p=0.01), CRP (-0.03, p=0;04) and SCr (-0.01, p= 0;02). Dyslipidemia and age were not significantly associated to BRS. In multivariate analysis, ScysC and gender (male) were the 2 covariates that independently and significantly associated with BRS. Conclusion By reporting for the first time an association between ScysC and BRS, our data suggest a new mechanism by which ScysC could predict excess risk of morbi-mortality beyond its sole ability to predict GFR. ScysC could be an easy-to-monitor marker of the “inflammatory reflex”.

ObjectiveDefine analytic areas at a sub-regional level to better meet the needs of local decision-makers.IntroductionSince 1 January 2016, the Auvergne and Rhône-Alpes regions have merged as part of the territorial reform. The new region is composed of 12 departments and accounts for more than 8 million inhabitants. Its territory is heterogeneous in population density with very urban areas (Clermont-Ferrand, Grenoble, Lyon and Saint-Etienne) and important mountainous areas (Arc Alpin, Massif Central). In France since 2004, the syndromic surveillance system SurSaUD® [1] coordinated by the French Public Health Agency (Santé publique France) collects morbidity data on a daily basis from two data sources: the emergency departments (ED) network Oscour® and the emergency general practitioners SOS Médecins associations. In Auvergne-Rhône-Alpes, the number of structures participating in the scheme has gradually increased from 2006 to today; as of 1 September 2018, all emergency services (N = 84) and all SOS Médecins associations (N = 7) transmit their data on a daily basis. Both data sources collect medical diagnoses, using ICD10 codes in the ED network and specific medical thesaurus in SOS Médecins Associations.These data are routinely analyzed to detect and follow-up various expected or unusual public health events all over the territory [2]. A reflection on the analysis of monitoring data at the sub-regional level was conducted in the region in order to refine the analyses carried out and better meet the expectations of local partners.MethodsThe SurSaUD® system has been progressively upgraded in recent years reaching its regional completeness in 2018. At the same time, the quality of the data also improved, making it possible to work on finer spatial levels.Three infra-regional partitioning scenarios were studied: the Territorial Hospital Groups (GHT) created in 2016. Although they represents 15 groupings in our region, the 12 departments and the 3 emergency physicians networks, we wondered about the possibility of carrying out analyzes on this scale to answer to local needs. The former Rhône-Alpes region had the particularity of being endowed with three networks of emergency physicians rooted in the region for more than 10 years. These networks are:- The RENAU network (North Alpine Emergency Network) which covers the Savoie, Haute-Savoie, and part of Isère regions (including Grenoble University Hospital);- The RESUVAL network (emergency network of the Rhone Valley) which covers the Ain, the Rhône (including the University Hospital of Lyon), the Drôme, the Ardèche (except the northern part) and the rest of the Isère regions;- The REULIAN network (Loire and northern Ardèche emergency network) which covers the Loire (including the University Hospital of Saint-Etienne) and the northern part of Ardèche (Annonay).These networks were created to structure the sectors and the organization of health care provision in emergency medicine.ResultsA breakdown into departments seemed of little relevance due to the large number of departments within the region and the significant heterogeneity in terms of activity, data transmission and quality. At this departmental scale, the volume of activity in the number of emergency reports transmitted varies from 51,300 to 608,400 annual visits depending on the department. Similarly, the coding of diagnoses varies between 19% and 81%, depending on the department.For the 15 GHTs, very recent in the region, the organization is not yet homogeneous in terms of healthcare provision and business software. Indeed, GHTs represent between 53,000 and 514,000 annual emergency visits. In addition, the quality of the data provided varies from 10 to 94% of coded diagnoses. This breakdown was thus not finally retained.In order to have coherent territories of relatively homogeneous weight, three sectors were defined: the first two sectors relied on the networks of emergency physicians in the east and center of the region (RENAU and RésuVal). For the west, the territory of the REULIAN network was merged with the former Auvergne region, which was also consistent with medical practices. Consequently, these three networks make it possible to have a logic of organization of health care and present relatively balanced sectors. These sectors comprise between 21 and 34 emergency services, and account for one to three SOS Médecins associations. This represents between 545,000 and 1,028,000 annual visits to emergency services, and between 93,000 and 109,000 annual consultations with SOS Médecins. The transmission quality of emergency visits data at D + 1 varies between 51% and 73%.A breakdown into 3 sectors (West, Center, and East) was finally retained.To illustrate the situation, a study on the characteristics and sub-regional spatio-temporal diffusion of respiratory syncytial virus (RSV) bronchiolitis epidemics in children under 2 years in the Auvergne-Rhône-Alpes region did not show any major differences between sectors to identify the start of the outbreak (+/- 1 or 2 weeks). However, the identification of the start of the outbreak in 1 or 2 sectors only did not seem to trigger outbreak onset at regional level. There is therefore a delay in informing the start of the outbreak for the sector (and the facilities) concerned, which may also delay the possibility to adapt health care provision with respect to the epidemic peak.Another use of these sectors was performed during the surveillance of allergies in the region. In the spring, the pollens are different from one week to another and depending on the territory. Also, thanks to these three sectors, it is possible to refine the observations to allow a prevention closer to the field. In the spring of 2018, in the East sector, a peak higher than in previous years was observed, while in the other two sectors, this dynamics was relatively similar to the one observed over the last two years.ConclusionsThe 3 networks of emergency physicians in the former Rhône-Alpes region, which have been active for more than 10 years, show that there is a real logic of health care provision between facilities belonging to the same network (common health problems, geographical characteristics, etc.). It was therefore relevant to rely on these networks to propose a sub-regional breakdown. In order to balance the sectors (in terms of the number of reports of emergency visits, number of facilities, population), it was decided to group within the Western sector the REULIAN territory and the territory of the former AuvergneThe results of the study on bronchiolitis show that the analysis of the spread of RSV-related bronchiolitis outbreaks at the sub-regional level could allow a better anticipation of outbreak onset, and therefore of the epidemic peak which constitutes the main stake for the organization of health care provision. The interest of this surveillance in sectors will also have to be evaluated for other seasonal disease.References[1] Caserio-Schönemann C, Bousquet V, Fouillet A, Henry V. Le système de surveillance syndromique SurSaUD (R). Bull Epidémiol Hebd 2014;3-4:38-44.[2] Josseran L, Nicolau J, Caillère N, Astagneau P, Brücker G. Syndromic surveillance based on emergency department activity and crude mortality: two examples. Euro Surveill 2006;11:225-9.